Journal of Human Lactation

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Knowledge, Beliefs, and Practices Regarding Exclusive Breastfeeding of Infants Younger Than 6 Months in
Mozambique: A Qualitative Study
Maaike Arts, Diederike Geelhoed, Caroline De Schacht, Wendy Prosser, Cathrien Alons and Avone Pedro
J Hum Lact published online 22 December 2010
DOI: 10.1177/0890334410390039
The online version of this article can be found at:
http://jhl.sagepub.com/content/early/2010/10/07/0890334410390039

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Knowledge, Beliefs, and Practices Regarding Exclusive

Breastfeeding of Infants Younger Than 6 Months
in Mozambique: A Qualitative Study
Maaike Arts, MSc, Diederike Geelhoed, MD, PhD, Caroline De Schacht, MD, MSc,
Wendy Prosser, MPA, Cathrien Alons, MPH, and Avone Pedro, BS

Abstract
Only 37% of infants younger than 6 months in Mozambique are exclusively breastfed.
A qualitative assessment was undertaken to identify the knowledge, beliefs, and practices
around exclusive breastfeedingspecifically, those of mothers, fathers, grandmothers, and
nursesand to identify the support networks. Results show many barriers. In addition to
receiving breast milk, infants receive water, traditional medicines, and porridges before
6 months of age. Many mothers had heard of the recommendation to exclusively breastfeed
for 6 months. However, other family decision makers had heard less about exclusive breastfeeding, and many expressed doubts about its feasibility. Some of them expressed willingness to support exclusive breastfeeding if they were informed by health workers. Nurses
know the benefits of exclusive breastfeeding and pass this information on verbally but have
insufficient counseling skills. Interventions to improve exclusive breastfeeding should target family and community members and include training of health workers in counseling to
resolve breastfeeding problems.
Keywords: exclusive breastfeeding, barriers, Mozambique, practices

Received for review July 9, 2010; revised manuscript accepted for publication August 10, 2010.
No reported competing interests.
Maaike Arts is a nutritionist specializing in public health nutrition issues
and infant and young child feeding. She has worked in Mozambique for
3 years. She was affiliated with the Elizabeth Glaser Pediatric AIDS
Foundation, Mozambique, at the time of the study. Diederike Geelhoed,
MD, PhD, is a public health clinician in the field of reproductive health,
including HIV/AIDS, and has 20 years of postgraduate work experience in
clinical care, public health, and research, mostly in sub-Saharan Africa.
Diederike Geelhoed is affiliated with the International Centre for Reproductive
Health, Ghent University, Belgium. Caroline De Schacht, MD, MSc, is a
public health clinician with a diploma in tropical medicine and masters in
clinical trials and has worked in Mozambique for over 6 years as a clinical
advisor. She is affiliated with the Elizabeth Glaser Pediatric AIDS Foundation,
Mozambique. Wendy Prosser, MPA, worked for 5 years in Mozambique
focusing on HIV prevention, treatment, and Prevention of Mother to Child
Transmission programs and is currently working in Angola on child survival initiatives. She was affiliated with Population Services International,
Mozambique, at the time of the study. Cathrien Alons, MPH, is a public
health specialist and has more than 10 years of experience in international
health, including nutrition, maternal and child health, and HIV/AIDS. She
is currently the technical director for the Elizabeth Glaser Pediatric AIDS
Foundation in Mozambique. Avone Pedro is a nutritionist working at the
Ministry of Health of Mozambique.
Address correspondence to Caroline De Schacht, Rua Kwame Nkrumah
417, Maputo, Mozambique.
J Hum Lact XX(X), XXXX
DOI: 10.1177/0890334410390039
Copyright 2010 International Lactation Consultant Association

Universal exclusive breastfeeding (EBF) during the

first 6 months of life is one of the most effective interventions to prevent child mortality.1 Suboptimal infantfeeding practices contribute to 1.4 million deaths and
10% of the disease burden in children younger than
5 years.2 EBF for the first 6 months of life is recommended for all infants.3 Infants do not need any other
food or drink during this period, not even water4; unrestricted EBF results in ample milk production.5 Practically
all mothers can breastfeed, provided they have accurate
information, as well as support within their families and
communities and from the health care system.5-8 For
mothers living with HIV, the World Health Organization
(WHO) currently recommends that for settings where
national or sub-national authorities have decided that
the Maternal, Newborn and Child Health services will
principally promote and support breastfeeding and
antiretroviral (ARV) interventions as the strategy that
will most likely give infants born to mothers known to
be HIV-infected the greatest chance of HIV-free
survival mothers known to be HIV-infected (and
whose infants are HIV uninfected or of unknown
HIV status) should exclusively breastfeed their infants
for the first 6 months of life, introducing appropriate

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Arts et al

complementary foods thereafter, and continue breastfeeding for the first 12 months of life. Breastfeeding
should then only stop once a nutritionally adequate and
safe diet without breast milk can be provided. In addition, it is recommended to provide ARV medicines to
either the mother or the child, depending on the ARV
regimen that the mother followed during pregnancy and
childbirth.9
In Mozambique, HIV prevalence in pregnant women
was estimated at 16% in 2007.10 A risk analysis based
on a mathematical model of different feeding options
in the context of HIV showed that in Mozambique, in
areas with an infant mortality rate above 31 per 1000
(ie, in practically the entire country), EBF for the first
6 months is the feeding option with the highest rates
of HIV-free survival.11 However, EBF is an uncommon
practice in many countries in sub-Saharan Africa,
and only 37% of all infants younger than 6 months in
Mozambique are exclusively breastfed.12
At the time of the study, the Ministry of Health recommended that all women EBF for 6 months. Mothers with
HIV were counseled to choose either EBF or exclusive
replacement feeding, if they were able to do so in a
way that was affordable, feasible, acceptable, sustainable, and safe. Mothers who opted for EBF were counseled to wean their children at the age of 6 months. The
most recent recommendations from the WHO
regarding ARV prophylaxis during breastfeeding13 are
currently being adapted for Mozambique. The country
started implementing the Baby-Friendly Hospital
Initiative in the end of the 1990s, but no hospitals have
been certified as baby-friendly.
To inform the development of a national strategy on
the promotion, protection, and support of breastfeeding
in Mozambique, of which EBF is a key component, a
qualitative assessment of the barriers to EBF was undertaken in 4 provinces and the capital city, covering all
3 regions of the country (north, center, and south). The
objectives of the assessment were threefold: (1) identify
the practices and beliefs around breastfeeding (specifically, EBF) of mothers, fathers, mothers-in-law, and
maternal and child health (MCH) nurses in Mozambique;
(2) describe the knowledge and attitudes of MCH nurses
on infant feeding and their influence on mothers; and
(3) identify the support networks in the area of infant
feeding that are available to mothers.

J Hum Lact XX(X), XXXX

Nampula) and the capital Maputo City. In each province, an urban site and a rural site were purposefully
selected, which led to a total number of 9 study sites,
including the urban site of Maputo City. Data collection
was done in July and August 2008.
In every site, a trained facilitator conducted 4 focus
group discussions (FGDs), each comprising a specific
category: mothers of children younger than 2 years,
mothers-in-law or grandmothers, fathers of children
younger than 2 years, and MCH nurses. The facilitators
were mostly community-based workers, some with previous experience in FGD. Each group had 8 to 12 participants. FGDs were based on a semistructured guide.
Questions in all 4 groups covered the same issues:
initiation of breastfeeding, available support for breastfeeding, decision making about infant feeding, additional foods and liquids provided to infants younger
than 6 months, perceptions of the feasibility of EBF, and
knowledge and perceptions about breastfeeding by HIVpositive women. Additional questions were asked to the
MCH nurses on their role as service providers.
Participants were selected through volunteer sampling among the specific categories described in the
previous paragraph, irrespective of their HIV status,
with the exception of 2 FGDs with mothers (Zambzia
and Gaza) who belonged to a local Prevention of Mother
to Child Transmission support group. The discussions
were recorded on tape and conducted in the presence
of a trained note taker. Local languages were used in all
groups except the MCH nurses, who spoke Portuguese.
Notes for all groups were made in Portuguese. The taped
discussions were translated into Portuguese and transcribed into Microsoft Word by the facilitator and note
taker teams. Thematic analysis was done manually
by 3 investigators in discussion until consensus was
reached. Saturation was achieved on the main themes.
The research protocol was approved by the Mozambican
Bioethics Committee. Participants gave verbal informed
consent after the purpose and proceedings of the study
were explained to them.
Results

The total number of participants in the 36 FGDs (20

urban, 16 rural) was 342: 95 mothers, 82 mothers-inlaw/grandmothers, 85 fathers, and 80 MCH nurses.
Practices and Beliefs Around Breastfeeding

Methods

A qualitative study was done in 4 of Mozambiques 11 provinces (Gaza, Tete, Zambzia, and

All groups mentioned that breast milk is usually the

first food given after a baby is born, although breastfeeding is not always initiated in the first hour after

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J Hum Lact XX(X), XXXX

Exclusive Breastfeeding of Infants Under 6 Months

birth. Reasons for this practice are related to the perceived need for the mother to rest and bathe after
delivery.
The baby is put to the breast for the first time after
more than one hour, because after [the baby] is
born, the mother is tired, and when she wakes up,
that is when she breastfeeds. (FGD mothers-inlaw/grandmothers, Xai-Xai City, Gaza Province)
There appeared to be different views about the
health benefit of colostrum for an infant. Some respondents said that colostrum is good, but others said that
the first milk is not good for the infant. No further detail
on this was explored.
Although the practice of breastfeeding appeared to
be nearly universal, participants commonly mentioned
that other foods or liquids were introduced before a child
reached the age of 6 months. Three kinds of foods and
liquids were identified. First, one widely held belief was
that children need to drink water from a very early age,
for their general well-being. Second, there was strong
evidence for the provision of traditional medicines to
children of all ages. Some of these medicines are given
through a bath, a smoking pipe, or an amulet, but others
are given orally, mostly in the form of a tea. Gripe
watera pharmacy-sold liquid with essential oils of
certain herbs, sodium bicarbonate, and sugarwas also
mentioned as a traditional medicine for oral use. The
participants stated that traditional medicines are given to
children to prevent and cure common illnesses, including
colic and diarrhea, as well as the doena de lua (moon
disease) and other illnesses and symptoms deemed spiritual or caused by spirits.
[People] give the [traditional] medicine so that children dont become ill and so that the mother can
have sexual relations with her husband without any
problem, so that when a sorcerer appears he will not
be able to harm the child. (FGD mothers-in-law/
grandmothers, Nacala Porto, Nampula Province)
The age at which traditional medicines are introduced varies, but it reportedly often starts in the first
weeks of life; many respondents referred to the time
when the umbilical cord falls off as the moment to start
giving traditional medicines. The description of the
amounts of traditional medicines that are given orally
was not very specific; respondents mentioned one
spoonful or a few spoonfuls. It was not possible to
obtain a more detailed description of the amounts.

Mothers and fathers both said that it is hard for a

mother to refuse to give traditional medicines when
another family member (most often, the childs grandmother) suggests that the child needs them. If a mother
refuses to use traditional medicines on her child and
something happens to the child, then the mother has to
take the responsibility for this, which places her in a difficult position within the family. Another argument that
participants used was that these medicines were good
because they themselves had benefited from them as
children. Some mothers, mothers-in-law, and fathers did
not support the use of traditional medicines, for reasons
mostly related to their Christian religious beliefs.
When a mother decides not to give the [traditional] medicine to the child, conflicts arise within
the family, because they say that the mother does
not want to follow advice, and that the child will
die of not having taken [traditional] medicine.
(FGD mothers, Xai-Xai City, Gaza Province)
The third category of foods to be given to children
before the age of 6 months are porridges (papas). These
are given because of the assumption that children need
to practice eating soft or blended foods before eating
solid foods later on and because children need these
foods in addition to breast milk to grow well. Although
many respondents said that porridges are introduced at
the ages of 4, 5, or 6 months, earlier ages were mentioned quite regularly. Decision making about the introduction of these porridges appeared to be a process
in which various actors are involved. All groups of
respondents felt that they were involved in the decision
making. Some said that it was a consultative process
involving the parents and significant others. The childs
grandmother was often mentioned to have an important
role in this process.
Many mothers had heard of the recommendation to
breastfeed exclusively for 6 months. However, knowledge
of this recommendation was less widespread among the
mothers-in-law and fathers. In these groups, many doubts
were expressed when the participants were asked if
they thought that EBF was feasible. It was believed that
breastfeeding alone is not sufficient to nurture a child
up to the age of 6 months, and the respondents believed
that mothers nutritional status is inadequate. Some
participants mentioned that mothers who work or study
outside the house cannot continue to breastfeed exclusively. The strong perceived need to give water, traditional medicines, and/or porridges was mentioned in the
context of the feasibility of EBF.

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Arts et al

Children will die, breast milk only is not enough

to fill the stomach of the baby, and if the child
is thirsty, it will die. (FGD mothers-in-law/
grandmothers, Domu, Tete Province)
Some influential family members, such as mothers-inlaw and fathers, expressed a willingness to support EBF.
They said that it would be easy to accept the recommendation if the information came from the health center.
[We should] not listen to what other people say
at home, we need to listen to that what the nurses
say, and comply with that. (FGD mothers, Alto
Molocue, Zambzia Province)
In all focus groups, the participants were asked about
the feeding of infants of HIV-positive mothers. Many
mothers-in-law and fathers said that they did not
know how these infants need to be fed, although mothers appeared to have somewhat better knowledge of the
current recommendations. Among the participants who
had heard about the feeding recommendations, some
said that HIV-positive women should breastfeed up to
6 months, and others thought or had heard that HIVpositive women should not breastfeed at all. MCH
nurses said that mothers should breastfeed for 6 months
and replacement feed when possible, which was the recommendation of the Ministry of Health at the time of the
study. However, nearly none of the participants, including the nurses, mentioned the importance of EBF for
the prevention of mother-to-child HIV transmission. In
addition, a common belief was that mothers who do not
breastfeed are suspected of being sick (including having HIV or AIDS), of not wanting or liking their children,
or of being a sorcerer.
If she does not breastfeed, people say that she
is a sorcerer, and wants the child to die. (FGD
mothers-in-law/grandmothers, Milange, Zambzia
Province)
Role of MCH Nurses in Infant Feeding

When the nurses were asked about their role in support of breastfeeding, they stressed that they informed
mothers well and gave them all the necessary information. Some expressed doubts about the feasibility because they assumed that the health and nutritional status of mothers is not sufficient and because of

J Hum Lact XX(X), XXXX

the perceived need to give water, traditional medicines,

and porridges before 6 months.
Many nurses reported that speaking to the mothers
is not enough to ensure EBF and that it is necessary to
address mothers-in-law, fathers, and communities in
general. Various nurses suggested involving peer educators and community leaders. Many nurses also mentioned constraints in their worknamely, the lack of
time to do counseling and a lack of job aids. They recommended that they receive additional training, support
for transportation to the communities, and job aids.
It is difficult because when I talk [with the mothers]
they may understand the message, but in practice
they do not follow it. (FGD MCH nurses, Angnia,
Tete Province)
Support Networks for Infant Feeding

Mothers often reported receiving support with the

initiation of breastfeeding from their mothers-in-law,
their mothers, other experienced women, as well as
from nurses, in the form of informative messages and
practical advice for positioning and attachment. Fathers
talked about nutritional support for their breastfeeding
partners and about sexual abstinence, because sexual
activity of a breastfeeding mother is traditionally deemed
harmful to the infant. Some mothers in Gaza and
Zambzia mentioned that they had not received any
support with breastfeeding.
I help with buying [artificial] baby milk, and
clothes, and with food for the mother for the production of more milk. I talk with my wife to give
breast milk, which is essential for the healthy
growth of the child. (FGD fathers, Maputo City)
My mother-in-law helped me to breastfeed for the
first time, she said to give one side and then the
other side, at times she herself took my breast and
gave it to the baby. (FGD mothers, Tete City, Tete
Province)
When asked what people do in case a mother experiences problems with breastfeeding, many mothers and
mothers-in-law said that the mother should go, or does
go, to the health center. To resolve a problem with insufficient milk production (or the perception thereof), many
respondents said that the mother needs to consume

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J Hum Lact XX(X), XXXX

Exclusive Breastfeeding of Infants Under 6 Months

specific foods, such as peanuts and coconut, or improve

her nutrition in general. Some mothers, mothers-in-law,
and fathers said that infant formula is also a good option
when there are breastfeeding problems but that they do
not have access to it. Although some nurses mentioned
interventions, such as emptying the breast well and offering both breasts during a feed, many of the nurses referred
to improving the mothers intake of foods and/or liquids
as a key intervention to improve breastfeeding, and some
said that they recommend mothers with breastfeeding
problems to obtain infant formula.
I advise my daughter-in-law to go to the hospital,
because if she would be sick, it can be transmitted
to the baby. (FGD mothers-in-law/grandmothers,
Domu, Tete Province)
Health centers normally refer mothers to the social services to receive artificial milk if necessary and based on
strict criteria.
It is interesting to note that throughout the survey, no
differences were observed in the answers provided by
the participants in the focus groups from the 3 regions
of the country.
Discussion

The results highlight the many barriers to EBF in

Mozambique and contribute to the explanation for the
low EBF rate in the country. Although not breastfeeding at all is rare and carries stigma, infants in the 3
regions of Mozambique usually receive water, traditional medicines, and porridges before reaching 6
months of age, in addition to breastfeeding, as also
documented in many other countries from sub-Saharan
Africa.14-16
Several barriers were identified that may inhibit
mothers from practicing EBF. First, although the participating mothers had typically heard of the recommendation to exclusively breastfeed for 6 months, grandmothers
and fathersas important members of the family who
are involved in the decision-making process on infant
feedinghad heard about it less often. The importance of family members in child care in general and
in infant feeding in particular has been documented in
other African countriesin Malawi, for example, where
paternal grandmothers have an important role in infant
and child care,17 or in Senegal, where the role of grandmothers in maternal and child nutrition practices appears
to be very large.18 Current information, education, and

communication activities on EBF in Mozambique are

only targeting mothers, however, usually in their health
clinic visits during pregnancy or for infant health care.
Grandmothers and fathers are rarely actively involved
in such activities, although there is some evidence that
they might have a positive influence on the adoption of
healthy infant care practices.17,18 Several grandmothers
and fathers participating in this study expressed their
willingness to support EBF if properly briefed by
health care personnel. Therefore, we recommend that
the Mozambican national strategy on the promotion, protection, and support of breastfeeding contain a component
of information, education, and communication activities
aimed at these influential family members to improve
their knowledge of the need for EBF in infants up to
6 months of age.
A second barrier to EBF identified from the results is
the common practice of giving water, traditional medicines, and/or porridges to infants younger than 6 months.
Many participants expressed doubts about the feasibility
of EBF, convinced that no baby could grow healthily
until the age of 6 months without adding these items to
their breastfeeding. Again, the mother did not appear to
be the principal decision maker on the administration of
traditional medicines nor on the introduction of water
or porridges, given that grandmothers and fathers were
described as family members with important influence
on these decisions. Similar to the results of another study
in southern Africa, these data show that the knowledge
that the mother obtained from health services alone is
insufficient to enable her to withstand the powerful influences on infant-feeding decisions of other family
members.16 To overcome this second barrier, we again
recommend the inclusion of specific measures in the
national breastfeeding strategy to ensure the active participation of grandmothers and fathers in the process
of improved implementation of EBF in infants until
6 months of age.
The third and last obstacle for the implementation
of EBF, as indicated by the results, is the issue of insufficient support for breastfeeding mothers from family
members and health care personnel, especially when they
face difficulties. Common constraints during breastfeeding, such as breast or nipple problems or a perceived
lack of milk, were reported as significant barriers for
the continuation of breastfeeding (as also documented
in Ghana19), which few participants, including nurses,
knew how to overcome. Although the participating nurses
appeared to know the benefits of EBF and managed to
pass this information on verbally, they felt that they had

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Arts et al

insufficient counseling skills, materials, and time to help

mothers overcome constraints. Our results show that
even health care personnel sometimes contribute to the
discontinuation of EBFfor example, when they recommend the early introduction of infant formula when
there is a perceived lack of breast milk, instead of measures to enhance the production of breast milk. Such
experience has been reported from Malawi.20 This is
unfortunate because our participants stated they relied
on the health care system to assist them in the management of breastfeeding problems. To overcome this third
barrier, we recommend capacity strengthening for
MCH nurses, which should include effective remedies or
guidelines for common breastfeeding problems, such as
engorgement, painful or cracked nipples, and perceived
insufficient milk production. MCH nurses are trained in
their preservice course and through in-service trainings
on EBF guidelines. These trainings focus on the transfer
of information and place less emphasis on the development of counseling skills and problem solving; thus,
they need to be adapted accordingly. In addition, some
participating grandmothers and fathersdespite their
perceive lack of preparedness in this areaexpressed
their interest to support EBF, particularly when a mother
is experiencing difficulties breastfeeding. To encourage
this willingness to support mothers to adhere to EBF,
we recommend including the opportunity for dialogue
with grandmothers and fathers on their support for such
remedies.
There is scientific evidence that support by health
care personnel as well as family and community members can indeed improve mothers breastfeeding practices. The WHO published an overview of possible
strategies,21 including the role of communities and community-based resource persons in providing support to
breastfeeding mothers, as based on a review of the literature and an analysis of 10 case studies. The summary of
the findings from the case studies demonstrates
1) the importance of community-based activities
for achieving scale, 2) the role of the community
as partners, not recipients, and 3) the feasibility
of improving practices through a comprehensive
approach that involves partnerships at many
levels, capacity building, behavior change communication, and the creation of an enabling
environment.21
A recent publication from KwaZulu Natal, South
Africa, reported how trained lay counselors discussed
infant-feeding choices and encouraged EBF among
pregnant and nursing mothers, which resulted in a longer

J Hum Lact XX(X), XXXX

period of EBF in supported mothers, compared to

mothers with less support.22-24 Another recent publication from South Africa advocates for community interventions to support mothers in their infant-feeding practices.25 The development of a national strategy on the
promotion, protection, and support of breastfeeding provides an excellent opportunity for Mozambique to recognize the importance of support of breastfeeding mothers
and thus incorporate strong policies to generate and sustain support for EBF within the family unit and the wider
community.
A limitation of our study is that, due to the insufficient experience of the field workers, some issues were
not explored in depth (eg, details on the administration
of traditional medicines). The original study plan was
to recruit mothers irrespective of their HIV status, but
because of a misunderstanding, all mothers in 2 sites
were HIV-positive. The analysis does not show any
difference between the groups, so we believe that the
misunderstanding did not impact the final outcomes.
Another limitation is the lack of triangulation; the
methodology did not foresee any in-depth interviews or
observations. However, we believed that for this exploration of the various issues that impede mothers to practice EBF, a more elaborate methodology would have
placed too much strain on the limited resources available for the study. The results fit well within the current
scientific knowledge reported from other countries in
southern Africa, and we are confident that the lack of
methods triangulation did not greatly reduce the validity
of the findings.
Although the dangers of the early introduction of
water and porridges are well documented, less is known
about the impact of traditional medicines on the health
of young infants, despite that it is frequently used in
young children.26 The traditional medicines mentioned
by the participants appear to be given for only short
periods and in small doses. Their effects on the infants
health may thus be very different from the more regular
and prolonged administration of water and porridges. It
would be useful to conduct more research on the composition, frequency, and amounts of traditional medicines given to infants in Mozambique; on their health
effects, including HIV transmission in HIV-exposed
infants; and on the possible options to administer these
products in a way that does not interfere with EBF.
There are some local experiences in which waiting to give traditional medicine until after 6 months
is acceptable and endorsed by community and traditional leaders. A continuing dialogue between the
formal and traditional health care systems on this matter is recommended.

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Exclusive Breastfeeding of Infants Under 6 Months

Given the study results, we conclude that interventions

to promote and support breastfeeding in Mozambique
should incorporate comprehensive communication strategies with a strong focus on influential family members
such as grandmothers and fathers. To improve EBF rates,
it is also crucial to include the capacity building of health
care personnel, particularly for breastfeeding counseling
and support and for the management of breastfeeding
problems, via the establishment of mother support groups
and outreach activities, for example. Revitalization of
the Baby-Friendly Hospital Initiative may further
increase the capacity of health staff regarding breastfeeding promotion. The Ministry of Health has recently
reintroduced the initiative with a training of trainers
for the southern provinces, and it is committed to follow it through. Family and community support for
breastfeeding should be promoted and supported. All
mothers, family members, and community members
should have sufficient knowledge about infant feeding
in the context of HIV. These interventions are laid
down in Mozambiques national strategy on the promotion, protection, and support of breastfeeding, as published in August 2009.27 This strategy is envisaged to be
implemented by the Mozambican Ministry of Health
in collaboration with its partners, such as nongovernmental organizations and community organizations,
United Nations agencies, and bilateral partners. Ideally,
these activities will increase the practice of EBF in
infants up to 6 months of age in Mozambique and support continued breastfeeding up to 2 years and beyond
and, as such, contribute to the reduction of infant morbidity and mortality in the country.
Acknowledgment

We thank the study participants, Provincial Health

Directorates, and Lourdes Fidalgo. This publication is
made possible by the support of the American people
through the USAID (the United States Agency for
International Development) and FICA (the Flemish
International Cooperation Agency). The contents are
the responsibility of the participating organizations
and do not necessarily reflect the views of USAID or
the US government.
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